Kais A Rona, MD1, Alex Yu, BS1, Caitlin Houghton, MD, FACS2, Nikolai Bildzukewicz, MD, FACS2, John C Lipham, MD, FACS2. 1Keck School of Medicine of USC, 2Keck Hospital of USC
INTRODUCTION: We have previously demonstrated excellent short-term outcomes following concomitant hiatal hernia repair (HHR) and magnetic sphincter augmentation (MSA) in patients with gastroesophageal reflux disease (GERD) and large hiatal hernias. The objective of our study was to report the efficacy and durability of this approach with respect to hiatal hernia recurrence, need for anti-secretory medications, and control of reflux symptoms.
METHODS AND PROCEDURES: This is a retrospective review of prospectively gathered data in all patients who underwent MSA and formal HHR at our institution between May 2009 and December 2015. Large hiatal hernias were measured intra-operatively and defined as those hernias measuring ≥ 3 cm. All patients underwent formal hiatal dissection with posterior cruroplasty. Surveillance for hiatal hernia recurrence was performed with a videoesophagram (VEG) and/or esophagogastroduodenoscopy (EGD) at 6 months, and yearly thereafter. Primary endpoints included hiatal hernia recurrence, proton-pump inhibitor (PPI) elimination rate, and GERD Health-Related Quality-of-Life (HRQL) scores.
RESULTS: 41 patients were identified who underwent HHR of a large hiatal hernia with concomitant MSA. Mean pre-operative DeMeester score was 52.4 (± 5.5) and mean hiatal hernia size was 4.0 cm (range 3-7 cm). Twelve patients (29.3%) were diagnosed with Barrett’s esophagus preoperatively. There was a significant decrease in GERD-HRQL score (19.6 vs. 2.8, p=0.036) with a PPI elimination rate of 92.7% following surgery. All patients underwent VEG (43.9%) and/or EGD (56.1%) to evaluate for hernia recurrence over a mean follow-up time of 15.1 months (range 6-38 months). One asymptomatic recurrence (2.4%) was diagnosed with a VEG at 11 months post-MSA.
CONCLUSION: Magnetic sphincter augmentation with a full hiatal dissection and posterior cruroplasty appears to be a durable and effective approach with a low hernia recurrence rate in patients with gastroesophageal reflux and a large hiatal hernia.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78720
Program Number: S080
Presentation Session: SAGES Got Talent : Resident & Fellow Scientific Session
Presentation Type: ResFel
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